Análise da imunoexpressão de BAX e MMP-9 no líquen plano oral / Analysis of BAX and MMP-9 immunoexpression in oral lichen planus

Introdução: O líquen plano oral é uma doença crônica imunologicamente mediada relativamente comum, que acomete a mucosa oral. Clinicamente, o LPO é classificado em seis padrões bem identificados: placa, reticular, bolhoso, atrófico, papular e erosivo.Sendo os mais comuns oos tipos reticulares e erosivos. A ativação dos linfócitos TCD4+ no LPO, pode induzir os ceratinócitos ao processo de apoptose através da respostaimunológica citotóxica. A proteína Bax desempenha uma função relevante para o processo apoptótico. Deste modo, a presente pesquisa consistiu em um estudo transversal retrospectivo, descritivo, quantitativo e comparativo. Objetivo: Avaliar a expressão imuno-histoquímica das proteínas MMP9 e Bax no LPO. Método: Foram utilizados 43 casos de LPO para análise da imunoexpressão de Bax e MMP-9. Os resultados foram analisados através dos testes estatísticos apropriados e serão considerados significativos, valores onde p<0,05. Resultado: A imunoexpressão de MMP9 foi significativamente maior nos ceratinócitos e quando analisados os subtipos de líquen plano oral, não foram observados diferenças estatísticas entre os tipos reticulares e erosivos para as proteínas analisadas. Conclusões: Com essas observações, infere-se que a alteração na expressão das proteínas estudadas sugere um distúrbio nos mecanismos apoptóticos, os quais estão associados às lesões de LPO, e podemos concluir também que as imunoexpressões dessas proteínas não apresentaram diferença, quando relacionada ao tipo clínico reticular ou erosivo. Com esse resultado pode-se contribuir para um maior entendimento sobre os possíveis mecanismos celulares envolvidos na etiopatogenia dessa lesão (AU).

Background: Oral lichen planus is a relatively common immune-mediated chronic disease that affects the oral mucosa. Clinically, OLP is classified into six well-identified patterns: plaque, reticular, bullous, atrophic, papular, and erosive. The most common being the reticular and erosive types. The activation of TCD4+ lymphocytes in the OLP can induce keratinocytes to the process of apoptosis through the cytotoxic immune response. Thus, the present research consisted of a retrospective, descriptive, quantitative and comparative crosssectional study. Objective: to evaluate the immunohistochemical expression of MMP-9 and Bax proteins in OLP. Methods: We used 20 cases of Inflammatory Fibrous Hyperplasia as control. The results were analyzed through the appropriate statistical tests and will be considered significant, values where p<0.05. Results: The immunoexpression of MMP-9 was significantly higher in keratinocytes and when the subtypes of oral lichen planus were analyzed, no statistical differences were observed between the reticular and erosive types for the proteins analyzed. Conclusions: With these observations, it is inferred that the alteration in the expression of the studied proteins suggests a disturbance in the proliferative and apoptotic mechanisms, which are associated with a pathological behavior of the oral mucosa, and consequently with a repercussion on the lesions of OLP, and we can also conclude that the immunoexpression of these proteins had no difference, when related to the reticular or erosive clinical type. This research aims to contribute to a greater understanding of the possible cellular mechanisms involved in the etiopathogenesis of this lesion, thus enabling the understanding of the clinical aspects of the pathology (AU).

Quality of Life in Patients with Chronic Oral Mucosal Conditions: A Qualitative Research

ABSTRACT Objective: To use qualitative research methods to evaluate the experiences of patients with chronic oral diseases. Material and Methods: Purposive sampling was used to recruit patients from the Oral Medicine Unit of Kerman University Dental School. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non-clinical setting. Focus groups were mixed regarding their gender, age, chronic oral mucosal condition, time since diagnosis, and severity. A total of 39 patients participated in the study, including patients with oral lichen planus, pemphigus, recurrent aphthous stomatitis and leukoplakia. Results: Analysis of the interviews revealed that patient views could be divided into the following themes: biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation. Chronic oral mucosal conditions affected patients' daily lives in various areas, from physical health and functioning to concerns about their future. Conclusion: The oral medicine practitioner's role in treating patients with chronic oral mucosal diseases extended beyond active management and symptomatic relief to the management of all aspects of these conditions that affected their daily lives.

Correlation Between Clinical and Histopathologic Diagnosis of Oral Potentially Malignant Disorder and Oral Squamous Cell Carcinoma

ABSTRACT Objective: To determine the frequency of oral potentially malignant disorders and Oral Squamous Cell Carcinoma (OSCC) and evaluate the consistency between their clinical and pathological features. Material and Methods: This retrospective study was conducted on records with a diagnosis of oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, lichen planus, and OSCC in the Pathology Department of Kerman dental school from September 1997 to September 2017. Data were analyzed in SPSS 21 at the significance level of ≤5%. Results: There were 378 cases of oral potentially malignant disorders and 70 cases of OSCC with a mean age of 46.82 ± 15.24 years. Buccal mucosa was the most frequent site, and lichen planus the most common lesion. Females were significantly older than males in leukoplakia and carcinoma in situ lesions. Clinical diagnosis and histopathology were consistent in 69.03% of cases. Conclusion: Clinical and histopathological diagnoses were consistent in 69.03% of records. The highest degree of clinical compliance with histopathology was observed in OSCC. Dentists should pay attention to oral potentially malignant disorders for early diagnosis to prevent their transformation to malignancy.

Assessment of oral health- related quality of life in patients with lichen planus during the course of treatment, using "Chronic Oral Mucosal Disease Questionnaire" / Avaliação da qualidade de vida relacionada à saúde bucal em pacientes com líquen plano durante o curso do tratamento, utilizando o "Questionário de Doença Oral Crônica

Objective: The aim of this study was to assess the oral health related quality of life in patients with oral lichen planus, using a Chronic Oral Mucosal Diseases Questionnaire (COMDQ) during a course of standard medical treatment. Material and Methods: In this experimental study, fifteen patients with oral lichen planus were entered the study and the COMDQ (a self-reported questionnaire assessing different aspects of quality of life in individuals with chronic oral mucosal diseases), was used to assess the level of "Pain and functional limitation", "Medication and treatment", "Social emotional" and "Patient support" during the course of standard treatment. A data collection form including demographic information, type and location of the lesions, patients' symptoms and level of healing process was completed. Patients were evaluated weekly during four weeks of treatment and COMDQ scores were documented. Data were analyzed, using ANOVA and Friedman statistical tests. Results:The mean score of the COMDQ questionnaire in lichen planus patients who completed the course of treatment, showed significant improvement (p < 0.001) after each week of therapy. Oral symptoms and the healing process of oral lesions showed improvement without any statistically significant changes among different weeks of therapy. "Pain and functional limitation", "Medication and treatment" and "Patient Support" improved significantly during the treatment period (p<001); however, the "Social and emotional" aspect did not show significant changes over the course of medical management. Conclusion: Oral health-related quality of life in patients with oral lichen planus improved significantly during the course of medical treatment. (AU)

Objetivo: O objetivo deste estudo foi avaliar a qualidade de vida relaciona à saúde oral em pacientes com líquen plano oral, utilizando o questionário de Doença oral crônica (Chronic Oral Mucosal Diseases Questionnaire -COMDQ) durante o curso de tratamento médico convencional. Material e Métodos: Neste estudo, foram incluídos quinze pacientes com líquen plano oral e o COMDQ (Um questionário de auto-avaliação que abrange diversos aspectos da qualidade de vida dos indivíduos com doenças orais crônicas) foi utilizado para avaliar o nível de "dor e limitação funciononal", "medicação e tratamento, "habilidades sócio-emocionais" e "suporte do paciente" durante o curso do tratamento. Também foram coletados dados como informações geográficas, tipo e local das lesões, sintomas dos pacientes e se a cicatrização das lesões foi completa. Os pacientes foram avaliados semanalmente durante 4 semanas e os escores do COMDQ foram documentados. Os dados foram analisados utilizando os testes estatísticos de ANOVA e Friedman. Resultados: O escore médio do questionário COMDQ em pacientes com líquen plano que completaram o tratamento, demonstrou melhora significativa (p < 0,001) após cada semana de tratamento. Sintomas orais e o processo de cicatrização das lesões orais mostrou melhoras entre as diferentes semanas de tratamento, porém sem significância estatística. "Dor e limitação functional, "Medicação e tratamento"e "suporte do paciente" aumentaram significativamente durante o período de tratamento (p < 0,001); No entanto, "habilidades sócio-emocionais" não apresentou alterações significantes durante o curso do manejo clínico. Conclusão: Qualidade de vida relacionada à saúde oral em pacientes com líquen plano melhora significativamente no decorrer do tratamento médico. (AU)

Análise clínico-patológica e qualitativa da expressão de mediadores inflamatórios teciduais no líquen plano oral / Clinicopathological and qualitative analysis of the expression of tissue inflammatory mediators in oral lichen planus

O líquen plano oral (LPO) é uma condição imuno-inflamatória mucocutânea crônica que ainda possui etiologia e patogênese desconhecidas. Estudos mostrando a participação de citocinas no LPO, em especial, interleucinas (IL)-6, IL-17 e IL-18, são escassos, assim como a correlação das características clínicas e histológicas das lesões de LPO com a presença destes mediadores inflamatórios. Todas as lesões de LPO e de lesões liquenoides orais (LLO) foram revisadas a partir do arquivo do laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro e as características clínico-patológicas dos casos foram analisadas. Foram selecionados 40 casos de LPO para realização adicional de reações imuno-histoquímicas para IL-6, IL-17 e IL-18. A amostra total foi composta por 221 casos e mostrou que o LPO apresentou predileção por mulheres adultas, mais frequentemente acometidas pelo padrão reticular e com lesões localizadas predominantemente na mucosa jugal. Os 40 casos selecionados para a avaliação imuno-histoquímica incluíram pacientes com média de idade de 53 anos, sem predileção por gênero, e com lesões localizadas preferencialmente na mucosa jugal (85%), na gengiva/mucosa alveolar (47%) e na língua (42%). Quanto ao padrão clínico, 14 pacientes (35%) mostravam lesões exclusivamente reticulares e 26 (65%) mostravam lesões reticulares associadas a lesões atrófico-erosivas. Sintomas foram relatados por 53% dos pacientes e incluíram principalmente ardência e desconforto local. A análise histológica mostrou que o epitélio das lesões mostrava espessura normal, atrófica ou hiperplásica em, respectivamente, 17 (43%), 9 (22%) e 14 (35%) casos. A presença de hiperqueratose foi observada em 21 casos (53%) e exocitose de linfócitos T CD4+ e T CD8+ estava presente em, respectivamente, 17 (42%) e 30 (75%) casos. A análise imuno-histoquímica revelou que a IL-6 foi, de forma geral, a mais expressa, tanto no epitélio, quanto no conjuntivo. A expressão de IL-17 se mostrou intensa no tecido conjuntivo, em 40% dos casos. A IL-18 mostrou intensidade mais frequente leve/moderada tanto no epitélio (40%), quanto no tecido conjuntivo (45%). A presença de exocitose mostrou relação com a maior expressão das ILs e a expressão de IL-17 foi maior no epitélio mostrando hiperqueratose. Os resultados do presente estudo mostraram que as características clínicas das lesões de LPO e de LLO são distintas e podem ser utilizadas para diferenciação entre as duas entidades. Os achados histológicos e imunohistoquímicos sugerem que as ILs estudadas mostram-se mais presentes quando há exocitose linfócitos T CD4+ e T CD8+ e que sua expressão pode ter relação com as alterações epiteliais encontradas no LPO, participando da patogênese e da modulação da expressão da doença.

Oral lichen planus (OLP) is a chronic immunoinflammatory mucocutaneous condition of unknown etiology and pathogenesis. Studies focusing on the presence of cytokines in OLP, especially interleukin (IL)-6, IL-17 and IL-18, are scarce, as well as the correlation of clinical and histological characteristics with the presence of inflammatory mediators. All lesions diagnosed as OLP and oral lichenoid lesions (OLL) were reviewed from the files of the Oral Pathology laboratory, Dental School, Rio de Janeiro State University, and their clinicopathological characteristics were analyzed. Forty cases diagnosed as OLP were selected for additional immunohistochemical reactions directed against IL-6, IL-17 e IL-18. The total sample was composed by 221 cases and showed that OLP presented a predilection for adult females, mostly affected by lesions with the reticular pattern and located in the buccal mucosa. The 40 cases selected for the immunohistochemical reactions included patients with a mean age of 53 years, with no gender predilection, and with lesions located mostly in the buccal mucosa (85%), gingiva/alveolar mucosa (47%) and tongue (42%). The clinical pattern showed reticular lesions in 14 patients (35%) and reticular and atrophic/erosive lesions in 26 patients (65%). Symptoms were reported by 53% of the patients and included mostly burning sensation and local discomfort. Histological analysis showed that the epithelial thickness was normal, atrophic, or hyperplastic in, respectively, 17 (43%), 9 (22%) and 14 (35%) cases. The presence of hyperkeratosis was observed in 21 cases (53%), and exocytosis of T CD4+ and T CD8+ lymphocytes was present in, respectively, 17 (42%) and 30 (75%) cases. Immunohistochemical analysis showed that, in general, IL-6 was the most expressed IL both in epithelium and connective tissue. IL-17 expression was considered intense in the connective tissue from 40% of the cases. IL-18 expression was considered mostly mild/moderate both in epithelium (40% of the cases) and connective tissue (45% of the cases). The presence of exocytosis was associated with a higher expression of the ILs and expression of IL-17 was higher in epithelium showing hyperkeratosis. The results from the present study showed that the clinical characteristics of OLP and OLL are distinct and can be useful in differentiating these two diagnostic entities. The histological and immunohistochemical features suggest that the studied ILs are more expressed when there is exocytosis of both T CD4+ and T CD8+ lymphocytes. Expression of the ILs can be associated with the epithelial alterations encountered in OLP, participating in the pathogenesis and modulating the expression of the disease.

Líquen plano oral: um relato de caso / Oral lichen planus: a case report

O líquen plano oral é uma doença crônica sistêmica comum, que se caracteriza por ser mucocutânea, autoimune, porém de etiologia incerta. O objetivo do presente trabalho é o de relatar um caso clínico com diagnóstico precoce e tratamento imediato, bem como acompanhamento de sua evolução. Foi descrito o caso de uma paciente do serviço de Traumatologia Buco-Maxilo-Facial do Hospital Universitário Oswaldo Cruz ­ HUOC. O teste para hepatite C se mostrou negativo para a paciente-alvo de nosso estudo e não há traços de transformação maligna nas lesões, considerando o acompanhamento clínico de 6 meses. O líquen plano oral necessita de diagnóstico preciso, para que a implementação de uma correta conduta terapêutica possa ser realizada... (AU)

Oral lichen planus is a common chronic systemic disease characterized as a mucocutaneous, autoimmune but of uncertain etiology. The aim of this study was to report a case with early diagnosis, prompt treatment and a six-month follow-up. It described the case of a patient of Buco-Maxillofacial Service of the University Hospital Oswaldo Cruz - HUOC. The test for hepatitis C was negative for the patient and no traces of malignant transformation lesions was found, taking into account the clinical six-month follow-up. Oral lichen planus requires an accurate diagnosis for the implementation of a correct approach therapy... (AU)

Estudo da imunoexpressão do VEGF165 e do VEGF165B em lesões orais de líquen plano e pênfigo vulgar / Study of VEGF165 and VEGF165B immunoexpression in oral lesions of lichen planus and pemphigus vulgaris

O Líquen Plano Oral (LPO) é uma doença mucocutânea mediada imunologicamente, de etiologia desconhecida, relativamente comum, com prevalências, na população mundial, que variam de 0,22 a 5%. O pênfigo vulgar é uma doença autoimue crônica que pode acometer a mucosa oral sendo o mais comum dos tipos de pênfigo. Entretanto, sua ocorrência é rara, com incidência estimada na população geral de um a cinco casos por milhão de pessoas diagnosticadas a cada ano. O VEGF-A é a proteína angiogênica mais potente tanto na angiogênese normal quanto na patológica. O splicing alternativo do éxon 8 do gene do VEGFA dá origem a duas famílias conhecidas de proteínas isofórmicas, uma desempenhando papel angiogênico, VEGFxxxa, e outra um papel antiangiogênico, VEGFxxxb. Este trabalho se propôs a avaliar a expressão imunoistoquímica do VEGF165 (angiogênico), do VEGF165b (antiangiogênico) em 46 casos de LPO reticular, 23 casos de LPO erosivo e 12 casos de PV, usando como controle 11 casos de hiperplasia fibrosa. Todos os espécimes das lesões e os casos controle foram divididos em e zonas para a análise das marcações, em zona superficial (Z1), média (Z2) e profunda (Z3). Os resultados deste experimento foram submetidos a testes estatístico não-paramétricos com nível de significância de 5%. Comparando apenas as lesões para o marcador anti-VEGF165 foram observadas diferenças significativas apenas nas zonas mais profundas entre as lesões de LPO reticular e PV, e entre as lesões de LPO erosivo e PV. Para o marcador anti-VEGF165b diferenças significativas foram observadas nas zonas médias entre as lesões de LPO reticular e PV; e nas zonas profundas entre LPO erosivo e PV e entre LPO reticular e PV. Avaliando o marcador VEGF165b nos espécimes sem categorizá-los por zonas foram observadas diferenças significativas entre as lesões de LPO reticular e PV. Na análise da correlação entre ambos os marcadores em cada lesão foram observadas correlação positiva fraca e significativa nas zonas média e profunda do LPO reticular e na zona superficial do LPO erosivo. Os resultados do presente estudo sugerem a participação do processo angiogênico na patogênese do LPO e na progressão das lesões de líquen plano oral e pênfigo vulgar, porém outros estudos devem ser realizados a fim de que esses achados, principalmente em relação ao pênfigo vulgar seja fundamentado, uma vez que a presente pesquisa é uma das primeiras que avalia a angiogênese na lesão já estabelecida dessa doença (AU).

Oral Lichen Planus is an immunologically mediated mucocutaneous disease of relatively unknown etiology with prevalences in the world population varying from 0.22 to 5%. Pemphigus vulgaris is a chronic autoimmune disease that may affect the oral mucosa being the most common type of pemphigus. However, its occurrence is rare, with an estimated incidence in the general population of one to five cases per million people diagnosed each year. Angiogenesis plays an important role in tumor growth and in the progression of chronic inflammatory diseases. VEGF-A is the most potent angiogenic protein in both normal and pathological angiogenesis. The alternative splicing of exon 8 VEGF-A gene gives rise to two known families of isoform proteins, one playing angiogenic role, VEGFxxxa, and another an antiangiogenic role, VEGFxxxb. The aim of this study was to evaluate the immunohistochemical expression of VEGF165 (angiogenic), VEGF165b (antiangiogenic) in 46 cases of reticular OLP, 23 cases of erosive OLP and 12 cases of PV, using as control 11 cases of fibrous hyperplasia. All specimens of the lesions and the control cases were divided into zones for the analysis of the immunohistochemical stains, in superficial (Z1), medium (Z2) and deep zones (Z3). The results of this experiment were submitted to non-parametric statistical tests with significance level of 5%. For all immunohistochemical stains the comparison between the lesions with the control group (HF) showed significant differences. Comparing only the lesions to the anti-VEGF165 stains, significant differences were observed only in the deeper zones between the reticular LPO lesions X PV; and between erosive LPO lesions X PV. For the anti-VEGF165b stains, significant differences were observed in medium zones between reticular OLP X PV lesions; and in deep zones between erosive LPO X PV and between reticular LPO and PV. And evaluating VEGF165b stains in specimens without categorizing them by zones was observed a significant difference between reticular LPO and PV lesions. In the analysis of the correlation between both markers in each lesion, a weak and significant positive correlation was observed in medium and deep zones of reticular OLP; and a weak positive correlation in superficial zone of erosive LPO. The present study results suggest angiogenic process participation in the pathogenesis and progression of lesions of oral lichen planus and pemphigus vulgaris. However other studies must be carried out in order that this implication, mainly in relation to pemphigus vulgaris be based once this is one of the first studies to evaluate angiogenesis in the already established lesion of this disease (AU).

Psychopathological profile and quality of life of patients with oral lichen planus

Abstract Objectives Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Material and Methods Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients' psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. Results We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). Conclusions In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients' quality of life.

Liquen plano bucal. Presentación de un caso / Oral lichen planus. Presentation of a case

El liquen plano es una enfermedad inflamatoria, eruptiva de la piel, pruriginosa, de marcha crónica o subaguda que puede involucrar las mucosas, sobre todo la bucal. Su etiología es desconocida, se relaciona con estímulos subjetivos (estados nerviosos, depresivos). Se mencionan también como posibles causas: las infecciones, los trastornos metabólicos y endocrinos, recientemente se ha considerado que la enfermedad puede presentar una reacción de hipersensibilidad retardada. El caso clínico del presente trabajo fue una paciente de 54 años de edad, remitida por su médico de familia con antecedentes de alteraciones psicosomáticas, resultado de un estrés mantenido durante un período de tiempo prolongado. Presentaba lesión en zona de carrillos derecho e izquierdo y en cara dorsal de lengua. Se interpretó como lesión inflamatoria no infecciosa de la mucosa bucal, la cual fue biopsiadas, lo que trajo como resultado el desarrollo de un liquen plano bucal. El diagnóstico fue corroborado por el examen histopatológico. A la paciente se le realizó tratamiento en diferentes etapas con ansiolíticos e inmuno moduladores, obteniéndose resultados satisfactorios.

Lichen planus is a pruriginous, eruptive inflammatory disease of the skin, of chronic or sub acute course that may involve mucosa, mainly the oral one. Its etiology is unknown, and is related with subjective stimuli (nervous, depressive status). Infections, metabolic and endocrine disorders are also mentioned as possible causes. Recently it has been considered that this disease may present a retarded hypersensibility reaction. The current work deals with the clinical case of a female patient, aged 54 years, who was referred by her family physician with antecedents of psychosomatic disorders, as a result of stress maintained during a long time period. She had a lesion in the area of the right and left cheeks, and in the dorsal side of the tongue. It was taken as a non infectious, inflammatory lesion of the oral mucosa, from which a biopsy was obtained, resulting in the development of an oral lichen planus. The diagnosis was corroborated by histopathological examination. The patient was treated in different stages with anxiolitics and immunomodulators, achieving satisfactory results.

Potentially malignant oral lesions: clinicopathological correlations / Lesões orais potencialmente malignas: correlações clínico-patológicas

ABSTRACT Objective To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. Methods The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). Results Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). Conclusion In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.

RESUMO Objetivo Verificar a incidência das lesões orais potencialmente malignas, e avaliar e correlacionar seus aspectos clínico-patológicos. Métodos A amostra foi composta pelos casos diagnosticados clinicamente como leucoplasia oral, eritroplasia oral, eritroleucoplasia, queilite actínica e líquen plano oral em um serviço de diagnóstico no período entre maio de 2012 e julho de 2013. Foram realizados testes estatísticos adotando-se nível de significância de 5% (p≤0,05). Resultados Dos 340 pacientes examinados, 106 (31,2%) se apresentaram com lesões orais potencialmente malignas; destes, 61 (17,9%) biópsias foram realizadas. A lesão mais frequente foi a queilite actínica (37,5%), e o sítio anatômico mais acometido foi o lábio inferior (49,6%). Entre os 106 pacientes da amostra, 48 (45,3%) relataram consumo de nicotina, 35 (33%) ingeriam bebidas alcoólicas e 34 (32,1%) trabalhavam expostos ao sol. Comparando o diagnóstico clínico com o histopatológico, as lesões que apresentaram maior compatibilidade foram a eritroplasia oral e a lesão ulcerada atípica (100% ambas). Conclusão Na maioria dos casos, houve compatibilidade do diagnóstico clínico com o histopatológico. Notou-se correlação entre a ocorrência de eritroplasia, leucoplasia e eritroleucoplasia com o hábito de fumar, e entre a queilite actínica com a exposição solar. A eritroleucoplasia foi a lesão que demonstrou maior grau de malignização neste estudo. Diante do exposto, recomenda-se maior atenção por parte dos cirurgiões-dentistas ao diagnóstico das lesões orais potencialmente malignas, para aplicação da melhor conduta e controle da lesão, impedindo sua transformação maligna.

Assessment of serum copper, iron and immune complexes in potentially malignant disorders and oral cancer

Abstract Potentially malignant disorders (PMDs) of oral cavity and oral cancer remain a cause of serious concern despite intensive research and development. Diet and immunity have been identified to play a crucial role as modifying factors in these diseases. Our study intended to explore this relationship by estimating and comparing the serum levels of copper, iron and circulating immune complexes (CICs) in patients diagnosed with PMDs and oral cancer and normal healthy individuals. In this study, 40 histopathologically diagnosed cases of PMDs and oral cancer were included along with 30 healthy controls and 5 ml of venous blood was drawn using venipuncture. Serum estimation of copper, iron and CIC then followed using the colorimetric and spectrophotometric methods. The data obtained was subjected to statistical analysis using one way ANOVA and Pearson's Product-Moment Correlation Test. The mean serum copper level was measured as 138.98 ± 10.13µg/100ml in the PMD group and 141.99 ± 21.44 µg/100ml in the oral cancer as compared to 105.5 + 18.81µ/100ml in the controls. The mean serum CIC levels was highest in the oral cancer (9.65 ± 0.16OD470) followed by the PMD group (0.18 + 0.21 OD470) and least in the control group (0.048 ± 0.02OD470). Whereas, the serum levels of iron showed a significant decrease in the PMD group (110.9 ± 10.54 µg/100ml) and the oral cancer group (114.29 ± 25.83 µg/100ml) as compared with the control group (136.85 ± 14.48 µg/100ml). There was no positive correlation obtained between the three groups with respect to the chosen parameters indicating that the variables were independent of each other. It can be thus be ascertained that trace elements like copper and iron as well as humoral responses (CICs) have a close relationship with PMDs and oral cancers.

TNF-α, TNF-ß and IL-10 gene polymorphism and association with oral lichen planus risk in Saudi patients

Objectives Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease. Cytokines play an important role in the pathogenesis and disease progression of OLP. Various reports have implicated cytokine gene polymorphisms in susceptibility to develop some immune mediated conditions including OLP. The purpose of this study was to investigate the association of tumor necrosis factor (TNF)-α, TNF-β and interleukin (IL)-10 gene polymorphisms with the OLP risk. Material and Methods Forty two unrelated patients with OLP and 211 healthy volunteers were genotyped for TNF-α (-308 G/A), TNF-β (+252A/G), IL-10 (-1082G/A), IL-10 (-819C/T), and IL-10 (-592C/A) polymorphisms. Results The frequencies of allele A and genotype GA of TNF-α (-308G/A) were significantly higher while allele G and GG genotypes were lower in OLP patients as compared to the controls (P<0.001). The frequency of GA genotype of TNF-β (+252A/G) was significantly higher in patients than in controls while the AA genotype was completely absent in OLP patients. These results indicated that allele A and genotype GA of TNF-α (-308G/A) as well as the GA genotype of TNF-β (+252A/G) polymorphisms are associated with OLP risk. The frequencies of alleles and genotypes of -1082G/A, -819C/T and -592C/A polymorphisms in IL-10 gene did not differ significantly between OLP patients and controls (P>0.05). However, haplotype ATA extracted from 1082G/A, -819C/T, -592C/A polymorphisms of IL-10 were more prevalent in OLP patients when compared to controls indicating its possible association with OLP susceptibility. Conclusion It is concluded that TNF-α (-308G/A), TNF-β (+252A/G) and IL-10 (-1082G/A, -819C/T and -592C/A) polymorphisms are associated with the susceptibility of OLP, thus giving additional support for the genetic basis of this disease. .

Estudo retrospectivo de Líquen Plano Bucal em um Centro de Especialidades Odontológicas / A retrospective study of Oral Lichen Planus in a Dental Specialties Center

Foi realizado um estudo retrospectivo com o objetivo de verificar o perfil epidemiológico dos pacientes com líquen plano bucal, registrados nos arquivos de um Centro de Especialidades Odontológicas (CEO), no período de setembro de 2006 a agosto de 2013. Observou-se a prevalência relacionada entre suas localizações, diferenças entre os sexos, doenças sistêmicas associadas, grupos etários e associação com o vírus de hepatite C. Foram avaliados os dados obtidos de 1816 prontuários, dos quais 35 tiveram diagnósticos de líquen plano, aco-metendo, principalmente, pacientes em uma faixa etária de 50 a 59 anos. A doença sistêmica associada mais prevalente foi hipertensão arterial, em que a população do sexo feminino foi a mais acometida. Pode-se observar, em relação ao total de indivíduos estudados, que não foi possível determinar uma influência significativa do vírus da hepatite C no aparecimento das lesões de líquen plano bucal... (AU)

The aim of this retrospective study is to verify the epidemiological profile of patients with oral lichen planus. It was evaluated the prevalence related to their location, and compared with smoking, gender, systemic diseases, age groups and association with hepatitis C virus registered in the archives of a Dental Specialty Center (CEO) in the period between September 2006 to February 2013. It was evaluated the data obtained from medical records of 1816 patients, of which 35 was clinical diagnosis lesions of oral lichen planus, affecting mainly patients in an age range from 50 to 59 years. The systemic disease more prevalent was arterial hypertension, and the female gender was more prevalent. In this study, it was not possible make any comparision of oral lichen planus and hepatitis C virus... (AU)

Líquen plano oral: reconhecendo a doença e suas características básicas / Oral lichen planus: recognizing thedisease and its basic feature

Introdução: o Líquen plano é uma doença mucocutânea comum, crônica e inflamatória. A Organização Mundial da Saúde classificou o líquen plano como uma doença cancerizável mas de difícil identificação dos agentes etiológicos. Contudo, o consumo de bebidas alcoólicas, tabaco, fatores genéticos, agentes infecciosos e imunológicos devem ser levados em consideração no potencial de malignização. Objetivo: a proposição deste trabalho é relatar uma revisão literária atualizada sobre o Líquen Plano Oral (LPO) focada em bases de dados nacionais e internacionais (Pubmed, Bireme). Busca de forma sucinta, explicitar o conceito, dados epidemiológicos, características clínicas e histopatológicas do LPO, bem como seu potencial de carcinogênese e formas de tratamento. Revisão de literatura: todo cirurgião dentista deve ter conhecimento das diferentes formas de líquen plano oral, procurando reconhecer os aspectos lesionais que indicam alteração de normalidade, diagnosticar corretamente as patologias e buscar um tratamento adequado ao paciente portador dessa e outras lesões. Considerações finais: a forma erosiva do LPO é considerada a única que tem potencial de carcinogênese, sendo o diagnóstico precoce e o tratamento adequado essenciais para o sucesso do tratamento. -

Introduction: The Lichen planus is a common mucocutaneous disease, chronic and inflammatory. The World Health Organization ranked the lichen planus as a disease that can turn malignant in about 2-3 per cent but it is difficult to identify the etiologic agents. However, alcohol consumption, tobacco, genetic, infectious and immunological agents should be taken into account in the malignant potential. Objective: the purpose of this work, from a literature review on the topic of oral lichen planus (OLP) focused on bases of national and international databases (Pubmed, BIREME). Succinctly get the concept, epidemiological data, clinical features and histopathology of OLP) and its potential for carcinogenesis and its forms of treatment. Literature review: emphasizing that every dentist should have knowledge of different forms of oral lichen planus, seeking to recognize the lesional aspects that indicate change of normality, correctly diagnosing the disease and seeking a suitable for your patient with this treatment and other injuries. Final considerations: The erosive form of OLP is the only one that has potential for carcinogenesis, with early diagnosis and proper treatment essential for successful treatment.

Detecção do HPV e EBV por nPCR em líquen plano bucal e tecido normal de cavidade bucal / Detection of HPV and EBV by nPCR in oral lichen planus and normal tissue of oral cavity

O líquen plano caracteriza-se como uma doença inflamatória crônica mucocutânea relativamente comum na população. Possui etiologia incerta, sendo possivelmente associado a fatores genéticos, psicológicos e infecciosos, dentre os quais o último vem ocupando um maior destaque devido a uma possível correlação com o vírus do papiloma humano (HPV) e com o Epstein-Barr vírus (EBV). O HPV possui alguns tipos considerados oncogênicos associados ao câncer de colo de útero e fortemente associado ao carcinoma espinocelular (CEC) de orofaringe. O EBV pertence à família herpesvirus humano e está relacionado com o carcinoma nasofaríngeo, linfoma de Burkitt e linfoma não-Hodgkin e sua possível relação com o CEC vem sendo estudada. O objetivo deste estudo foi detectar a presença do DNA do HPV e do EBV em amostras de tecido fresco, plasma sanguíneo, saliva e células esfoliadas orais, extraídas de um grupo pareado por sexo e idade de pacientes portadores de líquen plano bucal (LPB) e de um grupo de pacientes sem lesões de LPB, além de correlacionar as variáveis epidemiológicas dos grupos estudados com a presença viral e verificar se as fontes materiais testadas por este estudo são fontes viáveis para detecção do HPV e do EBV. Foram avaliados 24 pacientes portadores de LPB (Grupo caso) e 17 pacientes sem lesões de LPB (Grupo controle). A extração de DNA das amostras foi realizada após confirmar a presença e integridade do DNA. Os resultados obtidos foram submetidos à análise estatística (Teste exato de Fisher e Teste do Qui-Quadrado Mantel-Haenszel, ambos, com nível de significância de 5%). A nPCR foi utilizada para detecção do HPV e do EBV. Obteve-se a positividade viral para o HPV em 41,7% das amostras teciduais, em 12,5% das amostras de células esfoliadas e em nenhuma amostra de plasma sanguíneo e saliva dos pacientes do Grupo caso e em 52,9% das amostras teciduais e de saliva, 47,1% e 58,8% amostras de células esfoliadas e plasma sanguíneo, respectivamente, no Grupo controle...

Lichen planus is characterized as a chronic inflammatory mucocutaneous disease relatively common in the population. It has uncertain etiology, possibly associated with genetic, psychological and infectious factors. The infectious factor has excelled due the possible correlation of lichen planus with human papilloma virus (HPV) and Epstein-Barr virus (EBV). HPV has some types considered oncogenic, associated with cervical cancer and strongly associated with squamous cell carcinoma (SCC) of oropharynx. EBV belongs to human herpesvirus family and is associated with nasopharyngeal carcinoma, Burkitt's lymphoma and non-Hodgkin lymphoma. Its possible relation to SCC has been studied. The aim of this study was to detect the presence of the DNA of the HPV and EBV in fresh tissue samples, blood plasma, saliva and oral exfoliated cells extracted from a group of patients with oral lichen planus (OLP) paired by age and gender and from a group of patients without OLP lesions, and also correlate the epidemiological variables of the studied groups with the viral presence and verify that the source materials tested in this study are viable for HPV and EBV detection. It was evaluated 24 patients with OLP (Case group) and 17 patients without OLP lesions (Control group). DNA extraction of samples was performed after confirming the presence and integrity of DNA. The results were subjected to statistical analysis (Fisher's exact test and Mantel-Haenszel 19 chi-square test, both with a significance level of 5%). The nPCR was used to detect the presence of HPV and EBV. Was obtained the viral positivity for HPV in 41.7% of tissue samples and in 12.5% of exfoliated cells samples. No samples of blood plasma and saliva were positive in the Case group. On the other hand, the Control group showed a viral positivity of 52.9% in fresh tissue and saliva samples, 47.1% and 58.8% in samples of exfoliated cells and blood plasma, respectively. Was found positivity for EBV in 62.5% of tissue...

Estudo da expressão de genes relacionados à resposta inflamatória e autoimune em lesões de líquen plano oral do tipo reticular por meio de PCR-array / Study of the expression of inflammatory response-related genes and autoimmune in lesions of oral lichen planus reticular type by PCR-array

O líquen plano oral (LPO) é uma doença inflamatória crônica que afeta em torno de 1 a 2% da população mundial adulta, entre 30 e 60 anos, principalmente mulheres. As lesões podem estar presentes em diversos sítios, porém tem predileção pela mucosa jugal, gengiva e bordas laterais da língua, todas bilateralmente. As manifestações de LPO são frequentes, e podem se caracterizar clinicamente em seis tipos: reticular, em placas, papular, atrófico, erosivo-ulcerativo e bolhoso, porém o mais comum é o reticular. O presente estudo teve como objetivo avaliar a expressão de genes relacionados à resposta inflamatória e autoimunidade no líquen plano oral (LPO) em pacientes com a variante exclusivamente reticular comparado a controle saudável. Foram incluídos consecutivamente 10 pacientes com LPO que preencheram os critérios de inclusão adotados, sendo 9 mulheres e um homem, e 6 indivíduos controle, sendo 4 mulheres e 2 homens pareados por sexo, idade e uso de medicações sistêmicas. Amostras de mucosa bucal foram coletadas por meio de biópsia incisional em ambos os grupos de pacientes e submetidas à extração de RNA para posterior análise da expressão gênica por PCR-array selecionada para este estudo. Os resultados obtidos foram o aumento da expressão de 8 genes, CXCL 9 e CXCL 10 vão de acordo com a literatura, corroborando com nosso estudo e de certa forma reafirmar mais necessidade de estudos bem desenhados...

The oral lichen planus (OLP) is a chronic inflammatory disease that affects around 1-2% of the adult population between 30 and 60 years, mainly women. The lesions may be present in several sites, but has a predilection for the buccal mucosa, gums and lateral borders of the tongue, all bilaterally. The manifestations of OLP are frequent, and may be characterized clinically in six types: reticular, plaque-like, papular, atrophic, erosive-ulcerative and bullous, but the most common is the reticular . The present study aimed to evaluate the expression of genes related to inflammatory response and autoimmunity in oral lichen planus (OLP) in patients with exclusively reticular variant compared to healthy control. 10 consecutive patients with OLP who met the inclusion criteria, 9 women and one man, and six control subjects were included were 4 women and 2 being proportionally matched by sex, age and use of systemic medications men. Samples of oral mucosa were collected by incisional biopsy in both groups of patients and subjected to RNA extraction for analysis of gene expression by selected for this study-PCR array. The results were the overexpression of genes 8, where only two of them go according to the literature, corroborating our study and somehow reaffirm need for more well-designed studies...

Expresión inmunohistoquímica de p53 en individuos con liquen / Immunohistochemical expression of p53 in individuals with lichen planus

Objetivo: Estimar el riesgo del potencial de malignización del liquen plano bucal analizando la expresión de la proteína p53. Materiales y metodos: Se realizó un diseño de cohorte de sujetos con diagnostico histopatológico de liquen. El desenlace fue el desarrollo de cáncer si/no. El total de individuos que cumplió con los criterios de inclusión/exclusión fue de 58. A los 58 sujetos se les realizó la determinación de p53. Resultados: Cuarenta y nueve individuos mostraron una expresión de p53 menor al 5% con una P>0,05% intrasujeto no transformado. En los 9 individuos transformados se observaron diferencias significativas entre la determinación pre y post de la proteína p53. El Riesgo Relativo fue de 188 con una significación estadística de P< 0,01. Conclusion: La expresión de la proteína p53 en los individuos con liquen apoya la hipótesis que niveles superiores al 5%constituye un factor de incremento del riesgo en la transformación maligna de esta patología. Nuestros hallazgos deberían ser corroborados en el futuro con mayor número de individuos. La determinación de la p53 mediante IHQ en individuos con liquen plano bucal podría modificar el seguimiento clínico de estos individuos. Esto permitiría un diagnóstico precoz de cualquier alteración que pueda indicar un posible cambio hacia la malignización.

Objective: To determine the risk for potential malignant transformation of oral lichen planus by analyzing protein p53 expression. Materials and methods: Cohort study of subjects with a histopathologic diagnosis of lichen. The study analyzed whether or not subjects developed cancer. A total of 58 subjects fulfilled the inclusion/exclusion criteria, and were analyzed for p53. Results: Fortynine(49) subjects showed a p53 expression <5%, with a p>0.05 among subjects undergoing no transformation. In the 9 subjects undergoing malignant transformation, significant differences were observed between pre and post p53 expression. The relative risk was 188, with a statistical significance of p< 0.01. Conclusions: Protein p53 expression in subjects with lichen supports the hypothesis that levels >5% are associated with an increased risk of malignant transformation of this condition. Should our findings be proved in a larger series in the future, the clinical follow-up of these subjects could be modified. This would allow an early diagnosis of any disorder indicative of a potential malignant transformation.

A comparative study of apoptosis in reticular and erosive oral lichen planus

The oral lichen planus (OLP) is a chronic inflammatory disease, probably autoimmune, with different clinical forms. The most common types are the reticular and the erosive ones. Apoptosis participates in the destruction of basal keratinocytes, but its role in the perpetuation of the subepithelial lymphocytic infiltrates was not yet investigated. To evaluate the involvement of apoptosis in the epithelium and in subepithelial lymphocytic infiltrates, 15 samples of reticular and erosive OLP and 10 samples of healthy oral mucosa were collected and processed histologically. Apoptosis was quantified in the epithelium and in inflammatory cell infiltrates. TUNEL reaction was used to measure apoptosis in the infiltrates. Erosive OLP showed more intense epithelial apoptosis than reticular OLP and controls. In contrast, apoptosis in the inflammatory cell infiltrates was more frequent in reticular than in erosive OLP. Lymphocytes were the predominant cells within the inflammatory cell infiltrates and were more frequent in erosive OLP than in reticular type. These results suggest that different apoptotic levels are involved in the erosive/reticular switch in OLP, determining different clinical presentations. In conclusion, decreased apoptosis in inflammatory infiltrates may contribute to the persistence of T lymphocytes, worsening the attack to the epithelium in erosive OLP.

O líquen plano oral (LPO) é uma doença crônica inflamatória, provavelmente auto-imune, com diferentes formas clínicas. Os tipos mais comuns são o reticular e o erosivo. A apoptose participa da destruição dos ceratinócitos basais, no entanto o seu papel na perpetuação do infiltrado linfocitário subepitelial ainda não foi investigado. Para avaliar o envolvimento da apoptose no epitélio e no infiltrado linfocitário subepitelial, quinze amostras de LPO reticular, quinze de LPO erosivo e dez amostras de mucosa oral saudável foram coletadas e processadas histologicamente. A apoptose foi quantificada no epitélio e nas células do infiltrado inflamatório. A reação de TUNEL foi usada para mensurar a apoptose no infiltrado. A intensidade da apoptose no epitélio mostrou ser maior no LPO erosivo que no LPO reticular e estes foram maiores que no controle. Em contraste, a apoptose nas células do infiltrado inflamatório foi mais freqüente no LPO reticular que no LPO erosivo. Os linfócitos foram as células predominantes dentro do infiltrado inflamatório e foram mais freqüentes no tipo erosivo de LPO que no tipo reticular. Estes resultados sugerem que diferentes níveis de apoptose estão envolvidos no tipo erosivo e reticular de LPO, determinando as diferenças nas apresentações clínicas. Em conclusão, a diminuição da apoptose no infiltrado inflamatório pode contribuir para a persistência dos linfócitos T, piorando o ataque ao epitélio no LPO erosivo.

Papel da apoptose no infiltrado inflamatório do Líquen Plano Bucal / Inflammatory infiltrate of oral lichen planus of erosive and reticular types

O Liquen Plano Bucal (LPB) é uma doença inflamatória crônica auto-imune, cujas formas clínicas mais comuns são os tipos reticular e erosivo. A persistência do infiltrado inflamatório é importante para a patogênese do LPB, mas os mecanismos envolvidos neste processo ainda precisam ser mais onvestigados. A deficiência de apoptose pode contribuir para essa persistência do infiltrado subepitelial, que é composto predominantemente por linfócitos T CD4+ e CD8+. É sabido que o alvo das células CD8+ (LT citotóxicos) são ceratinócitos no LPB. O objetivo deste estudo foi avaliar se há bloqueio da apoptose nos linfócitos subepiteliais, elucidar as vias apoptóticas envolvidas, bem como quantificar os linfócitos T CD8+ nas lesões de LPB dos tipos reticular e erosivo...

Manejo estomatológico del liquen planooral atrófico: revisión de literatura y presentación de un caso / Dental management of atrophic oral lichen planus: literature review and case report

El liquen plano oral es una enfermedad de carácter autoinmune mucocutánea crónicay etiología desconocida. Las lesiones se presentan en la cavidad oral, la piel, las uñas ytambién pueden tener expresiones en los folículos pilosos de la cabeza. Presenta diversasformas clínicas entre las que se encuentra el patrón reticular, atrófico y erosivo. Esteúltimo es la forma clínica más asociada con una transformación maligna de las lesionesbucales. El diagnóstico es clínico-patológico y el tratamiento se basa en la terapia antiinflamatoriacon corticoides tópicos y sistémicos cuando se presenten las lesiones. Eneste artículo se describe el caso clínico de un paciente que acudió al servicio de estomatologíay cirugía oral de la Corporación Universitaria Rafael Núñez, con impresión clínicay patológica de liquen plano oral. Se empleó manejo farmacológico de las lesiones conuna mezcla de hidrocortisona (corticoide), vitamina A no ácida, vitamina E y lidocaína deOrabase. Se observaron buenos resultados con esta terapia...

Oral lichen planus is a common chronic autoimmune mucocutaneous disease of unknowncause. Lesions are commonly seen on the buccal mucosa of oral cavity, skin, and nailsand even in the head hair follicles. It has several clinical forms with white striae (Wickhamstriae) in the surface of the mucosa, white papules or plaques, atrophic, erosive or vesicularlesions. The malignancy potential of lichen planus is especially in the erosive form. Thediagnosis is usually achieved by clinical and histological examination. Treatment includesanti-inflammatory agents, particularly topical corticosteroids or systemic corticosteroidwhen there are systemic injuries. A clinical case of a patient who attended the oral surgerydental service of University Rafael Núñez is reported. He was diagnosed with as oral lichenplanus. Treatment of the lesions was based on a mixture of hydrocortisone (steroid), vitamin A,vitamin E, and lidocaine in Orabase, showing good results after the therapy...